We report invasive aspergillus sinusitis associated with intranasal prescription drug abuse (snorting) in 2 immunocompetent patients and 1 immunocompromised patient. Computed tomography (CT) scans, multiple sinus biopsies at the time of debridement, and fungal cultures were obtained. All 3 patients displayed severe mucosal damage as a result of crushing and snorting narcotic analgesic tablets. Each also reported a distant history of cocaine abuse. Each experienced septal wall perforation and collapse with biopsy results identifying branching septate hyphae on Giemsa stain. Pathology reports revealed polyp formation and sinus mucosa with marked acute and chronic inflammation, ulceration, and granulation. The clinical laboratory isolated Aspergillus flavus from tissue culture in all 3 patients. A tablet from the supply of patient 3 (immunocompromised), along with a separate lot of hydrocodone/acetaminophen tablets did not grow fungus when cultured. Patient 1 (immunocompetent) received amphotericin B for 4 weeks, and has had no evidence of relapse for 1 month; patient 2 (immunocompetent) received amphotericin B for 4 days, and continues on itraconazole with no signs of recurrent disease. Patient 3 has acute lyphocytic leukemia, and is completing a course of voriconazole via study protocol without relapse. A literature search produced no other case reports of patients having developed this condition as a result of intranasal drug abuse. Snorting analgesic agents appears to be a new risk factor for acquiring invasive aspergillus sinusitis.
Full conference title:
- IDSA 38th